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SCAI has been closely watching developments regarding a proposed HHS/CMS rule, filed with the Office of Management and Budget on August 10, titled “Cancellation of Advancing Care Coordination through Episode Payment and Cardiac Rehabilitation Incentive Payment Models; Changes to Comprehensive Care for Joint Replacement Payment Model (CMS-5524-P).” Based on the title, it has been anticipated that the mandatory AMI Bundled Program would be canceled. In April, SCAI expressed concerns and recommended revisions to the program that was slated to go into effect January 1, 2018, in a letter to Secretary Price.

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SCAI has been closely watching developments regarding a proposed HHS/CMS rule, filed with the Office of Management and Budget on August 10, titled “Cancellation of Advancing Care Coordination through Episode Payment and Cardiac Rehabilitation Incentive Payment Models; Changes to Comprehensive Care for Joint Replacement Payment Model (CMS-5524-P).” Based on the title, it has been anticipated that the mandatory AMI Bundled Program would be canceled. In April, SCAI expressed concerns and recommended revisions to the program that was slated to go into effect January 1, 2018, in a letter to Secretary Price.

On July 28th, three Republican Senators joined with all 48 Democrats to defeat the GOP leadership’s “skinny repeal” bill that would have repealed the Affordable Care Act’s (ACA) individual mandate and removed penalties under the employer mandate for eight years, while delaying the medical device excise tax until the end of 2020.

On June 22, 2017, United States Senate Majority Leader Mitch McConnell (R-KY) unveiled the Senate Republican leadership health care reform bill – the Better Care Reconciliation Act (BCRA) of 2017. While the Senate bill is slightly more moderate than its House counterpart, the Senate version would still allow states and insurance companies to opt out of many of the patient protections mandated under the Affordable Care Act.

On June 13, 2017, SCAI endorsed HR 1215, the Protecting Access to Care Act of 2017 — a medical liability reform legislation introduced by Representative Steve King (R-IA). In a letter to Congressman King, SCAI highlighted how there is "widespread agreement that our nation’s medical liability system is broken and does not serve the needs of our patient and that the 115th Congress must pass legislation that will make the necessary reforms at the federal level which will reduce health care costs, preserve patients’ access to medical care, and put an end to medical lawsuit abuse."

On June 13, 3017, SCAI submitted comments to CMS [link to attached comment letter] regarding the 2018 Inpatient Prospective Payment System (IPPS) Proposed Rule. SCAI expressed strong concern over CMS’s proposed 35% reduction to the DRG rate for percutaneous ventricular assist devices inpatient claims (MS-DRG 215), believed to be resulting due to the transition from the ICD-9 to ICD-10 coding system. SCAI also expressed support for physician owned hospitals, opposed the public release of inspection reports by accrediting organizations and spoke to working with CMS regarding the appropriate DRG assignment for new MI ICD-10 codes expected to be approved in October. SCAI will continue to monitor these issues of interest to SCAI members.

On May 24, 2017, the Congressional Budget Office (CBO) released its estimate of the revised American Health Care Act (AHCA), which the House narrowly passed on May 4th. Among other things, the CBO estimates that 23 million Americans would lose health insurance coverage by 2026 than under current law. The report also states that about one-sixth of the population resides in areas in which the nongroup market would start to become unstable beginning in 2020 because states in those areas are likely to opt for waivers that would eliminate essential health benefit requirements and community-rated premiums. SCAI will continue to provide updates regarding future congressional healthcare reform efforts. For more on the CBO report...

On May 4, 2017, the House narrowly approved the American Health Care Act (AHCA) by a party-line vote of 217-213 — paving the way for senate consideration where the bill will likely be extensively modified. The latest iteration of the bill would allow states that receive a waiver from the Secretary for Health and Human Services (HHS) to opt out of a number ACA provisions surrounding essential health benefits, community rating and pre-existing health conditions provided the state enacts a high-risk pool to subsidize the costs of these high-risk individuals. House Republicans proceeded with the floor vote today after a last minute change in the bill would provide an additional $8 billion to the $115 billion included for state and federal high-risk pools – to help reduce premiums or out-of-pocket costs for individuals with pre-existing conditions in states that receive waivers.

The final rule for the Medicare AMI Bundled Payment Program was issued last November. But, in response to a January 20th Executive Order, all regulations issued 60 days prior to President Trump taking office were subject to delay and re-review. Therefore, CMS issued a new proposed rule for a Delayed Bundled Payment Program proposing a delay to the start of the program until at least October 1, 2017. SCAI took the opportunity the delay provides to reach out directly to Secretary Price to reiterate concerns about the AMI Bundled Program [link underlined text to the attached comment letter] that CMS did not adequately address in the November final rule. CMS’s decision in regards to delaying the rule and whether CMS will make any revisions to the program including whether the program will shift to a voluntary program are expected to be addressed in the final rule for the Delayed Bundled Payment Rule expected to be issued on or about May 20th. SCAI’s Advocacy team will continue to closely monitor developments pertaining to the AMI Bundled Payment Program.

On April 28, 2017, SCAI President Kenneth Rosenfield sent a letter to every congressional office outlining SCAI’s new Healthcare Reform Principles, which SCAI believes should be reflected in any final healthcare reform package. Dr. Rosenfield urged legislators to work with SCAI and other stakeholders to develop a bipartisan approach toward strengthening our country's health care system so that Americans can have access to reliable, high quality and affordable healthcare. Following are SCAI’s Healthcare Reform Principles...

Anthem Blue Cross Blue Shield, the largest of the Blue Shield carriers in the United States does not currently cover Transcatheter Mitral Valve Repair (TMVR) under any circumstances. Key SCAI Structural Heart Disease Committee leaders, Clifford J. Kavinsky, MD. PhD, FSCAI and Ted Feldman, MD, MSCAI engaged representatives from Anthem’s coverage analysis team in a recent conference call to address Anthem’s lack of coverage for this fairly established technology that is thwarting patient access to TMVR. In follow-up to the exploratory call, SCAI submitted a letter to Anthem urging the carrier to come in line with other insurance carriers in finding Transcatheter Mitral Valve Repair NOT to be “experimental and investigational” and to find it “Medically Necessary” for a select sub-set of patients based on FDA approved indications for the MitraClip® device. You can read SCAI’s letter here...